Jackie asked
I'm switching from alprazolam to lorazepam, what is the ratio for comparing? Instead of taking 1 mg of alprazolam, do I take 2 mg of lorazepam? Thank you.
At a glance
- Alprazolam and lorazepam are both in the same class of medication, benzodiazepines. They are most commonly used to treat anxiety and acute panic attacks.
- Both medications work a bit differently. Alprazolam works a bit quicker and with greater intensity. Lorazepam is usually a bit less intense. It has a slower onset but usually lasts longer.
- Most of the information that we have regarding switching one benzodiazepine for another comes from studies done on patients using it for alcohol withdrawal, but they suggest that alprazolam is twice as potent when the same dose is given.
- Follow the directions on your prescription bottle that your physician wrote you.
Answer
Hi Jackie and thanks for reaching out to us.
First, alprazolam and lorazepam aren’t exactly interchangeable. They are both in the same class of medication, benzodiazepines and they both most are commonly used to treat anxiety or acute anxiety. That being said, they are certainly different medications with different properties. Alprazolam is a bit more of an “intense” medication. It has a faster onset and doesn’t last quite as long in your system. Lorazepam has a more gradual onset and sticks around in your body a bit longer. Additionally, it doesn’t seem to “hit” quite as hard as alprazolam.
Most of the studies that we have comparing one benzodiazepine against each other come from studies of patients using them to help withdraw from alcohol addiction. While these studies are useful, they generally aren't testing their use in those with anxiety symptoms, so the information gained might not be accurate for all treatments. Nevertheless, these studies suggest that alprazolam is, in general, about twice as potent as lorazepam when the same dose is administered. Therefore, alprazolam 0.5mg is roughly equivalent to lorazepam 1mg.
Ultimately, it’s not really safe to guess the dose of a medication that you should be taking as there are a lot of patient-specific considerations. You should consult with your physician as to what specific dose you should be taking. If you lost the directions, contact your local pharmacy and they would be happy to provide you with your current dose.
Benzodiazepines are notoriously difficult to wean off of, and stopping or changing doses too rapidly can cause some pretty uncomfortable withdrawal symptoms. Alprazolam has specifically been noted in studies as being one of the more challenging benzodiazepines in this regard since it is so potent and short-acting. I recommend you consult with your doctor to be safe.
I hope this helps! Feel free to write us again in the future.
References
- Management of withdrawal syndromes and relapse prevention in drug and alcohol dependence, American Family Physician
- Tintinalli's Emergency Medicine: A Comprehensive Study Guide. 7th ed. Chapter 177
